Utah hospital will use cannabis extract to treat kids with epilepsy

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Neurologists at Primary Children's Hospital are one step closer to being able to prescribe pharmaceutical-grade cannabis to children and teens with severe epilepsy.

Only those who apply to be part of a drug trial will be eligible  25 spots are available  and it's not known when the study will start.

The study's lead author, neurologist Francis Filloux, is waiting for a license from the Drug Enforcement Administration freeing him to handle Schedule 1 substances, said Ed Clark, chief medical officer at Primary Children's.

Schedule 1 drugs are considered the most dangerous and potentially addictive; the category includes heroin, LSD and marijuana. No doctor or researcher at Primary Children's or the University of Utah has a Schedule 1 license, Clark said. But he's confident Filloux will be approved.

"This is a federally approved study. I see no barriers other than bureaucracy," he said. "We're very excited to be doing this. Our teams here recognized that this was an emerging need and started to put this study together in 2013."

It's an open-label observational trial, which means everyone enrolled will receive Epidiolex, a liquid, purified form of cannabidiol (CBD), a nonpsychoactive chemical in marijuana. Epidiolex is manufactured by British drugmaker GW Pharmaceuticals.

GW Pharmaceuticals and the U.'s Institutional Review Board have approved Primary Children's as a study site.

The trial will be open to children ages 2 to 17 who have treatment-resistant epilepsy, defined as not responding to at least four anti-epileptic drugs.

The primary goal will be to test the tolerability of Epidiolex and the optimal dose of CBD, a chemical shown to have powerful anti-seizure properties in children who have tried whole-plant marijuana extracts.

Parent activists who pushed for Charlee's Law  which frees Utahns with epilepsy to import whole-plant CBD extracts from states where medical marijuana is legal  have long hoped Primary Children's would study Epidiolex.

But the timing of the study poses a challenge for families who are on a waiting list for a highly sought CBD oil made by Colorado Springs growers at the Realm of Caring Foundation.

Those families will be eligible to apply for a Utah "hemp supplement" registration card starting July 8. But taking the oil could exclude them from participating in Primary Children's study, which has an unknown start date.

"It's a decision point for families, to do this study or try a whole plant extract," acknowledged Clark.

Epidiolex is similar but not identical to "artisanal" CBD oils, which contain trace amounts of tetrahydrocannabinol (THC), the chemical in cannabis that gives users a high.

The artisanal oils have been shown to work for patients who have exhausted all other remedies. In an observational study of 19 epilepsy patients who tried such oils, nearly half had an 80 percent reduction in seizures and others saw a drop between 25 percent and 50 percent in seizure frequency.

"It's possible that CBD and THC work synergistically to control seizures," University of Colorado epilepsy expert Edward Maa wrote in May in the journal Epilepsia.

GW Pharmaceuticals, which has been conducting investigational drug trials of Epidiolex for a half year, hasn't formally published its findings.

But in a news release in June, the company announced that "of the patients who have responded to Epidiolex, a high proportion show a reduction in seizure frequency of greater than 50 percent and a portion of these patients were reported to be seizure-free at the end of 12 weeks of treatment."

Epidiolex has the advantage of being subject to federal safety controls. It comes in a uniform dose, unlike whole-plant extracts.

But it's likely to be much more expensive and not openly marketed for years. Families say they have been told to expect to pay $10,000 to $15,000 a year for the drug.

The Realm of Caring's product, though not covered by insurance, costs less than $200 a month.

Children will be enrolled in the Epidiolex drug trial on the advice of neurologists, who will draw study participants from their patient pool at Primary Children's Hospital.

Starting July 8, Utahns with untreatable epilepsy, children and adults, will be able to apply for a "hemp supplement" registration card authorizing them to import whole-plant cannabidiol extracts from states such as Colorado.

They must first obtain a letter from their doctor documenting their diagnosis. Utah law leaves it up to individual doctors whether to write such letters.

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